Abstract
Background
Outcomes after spinal cord stimulator (SCS) placement are affected by psychologic
comorbidities. It is part of routine practice to do psychologic assessments prior
to SCS trials to assess for the presence of maladaptive behavioral patterns. However,
few studies have sought to quantify the effect of psychiatric comorbidities on complications,
reoperation, and readmission rates. The purpose of this study was to assess the association
of psychiatric comorbidities with postprocedural outcomes after SCS implantation.
Materials and Methods
Inclusion criteria included SCS placement between 2015 and 2020 (percutaneous approach
or an open laminectomy-based approach) using Healthcare Corporation of America National
Database. Data on psychiatric comorbidities present at the time of SCS implantation
surgery were collected. Outcomes of interest included complication rates (defined
as lead migration, fracture, malfunction, battery failure, postoperative pain, infection,
dural puncture, or neurological injury), reoperation rates (defined as either revision
or explant [ie, removal]), and readmission rates within 30-day and 1-year time after
SCS implantation. We measured the association between psychiatric comorbidities and
outcomes using multivariable regression and reported odds ratio (OR) and respective
95% confidence intervals.
Results
A total of 12,751 cases were included. The most common psychiatric comorbidities were
major depressive disorder (16.1%) and anxiety disorder (13.4%). In unadjusted univariate
analysis, patients with any psychiatric comorbidity had heightened rates of any complication
(27.1% vs 19.4%), infection (5.9% vs 1.9%), lead displacement (2.2% vs 1.3%), surgical
pain (2.1% vs 1.2%), explant (14.7% vs 8.8%), and readmission rates at one year (54.2%
vs 33.8%) (all p < 0.001). In multivariable logistic regression, with each additional psychiatric
comorbidity, a patient had increased odds of experiencing any complication (OR = 1.5,
95% CI = 1.36–1.57, p < 0.001), requiring a reoperation (OR = 1.5, 95% CI = 1.37–1.6, p < 0.001), and requiring readmission (OR = 1.7, 99% CI = 1.6–1.8, p < 0.001).
Conclusions
The presence of psychiatric comorbidities was found to be associated with postoperative
complication rates, reoperation, and readmission rates after SCS placement. Furthermore,
each consecutive increase in psychiatric comorbidity burden was associated with increased
odds of complications, reoperation, and readmission. Future studies might consider
examining the role of presurgical mental health screening (ie, patient selection,
psychologic testing) and treatment in optimizing outcomes for patients with psychiatric
comorbidities.
Keywords
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Comments
Article info
Publication history
Published online: January 29, 2023
Accepted:
December 19,
2022
Received in revised form:
November 28,
2022
Received:
October 28,
2022
Publication stage
In Press Corrected ProofFootnotes
Source(s) of financial support: This research was supported (in whole or in part) by HCA Healthcare and/or an HCA Healthcare Affiliated Entity. The views expressed in this publication represent those of the author(s) and do not necessarily represent the official views of HCA Healthcare or any of its affiliated entities.
Conflict of Interest: Rodney A. Gabriel’s institution has received funding for research purposes from SPR Therapeutics, Epimed International, Inc, and InfuTronix. Rodney A. Gabriel serves as a paid consultant on behalf of his institution to Avanos Medical. All other authors reported no conflicts of interest.
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© 2023 International Neuromodulation Society. Published by Elsevier Inc. All rights reserved.
